Haematology

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A comparative study of iron deficiency in the Indian and the African in Durban.
(1963) Mayet, Fatima G. H.
The thesis is comprised of a comparative study of iron metabolism with particular reference to iron deficiency in the Indian and the African; Europeans were included when naterlal was available. Fifty four patients with iron deficiency anaemia were studied. There ware 43 Indians as compared with 11 Africans although the overall proportion of Indians to Africans admitted to the same ward was 1 : 4. Amongst the Indians the commonest cause of anaemia from blood loss was peptic ulceration (6 patients); while 3 had cirrhosis of the liver, one had hookworm anaemia and one was a case of ulcerative colitis. Gynaecological lesions were found in 2 patients, one had a proliferative endometrium and the other had endometrial polypi. Idiopathic iron deficiency anaemia was found in 60.5% of the Indian patients (both male and female). Amongst the Africans on the other hand, there were 2 cases of hookworm anaemia and 2 of cirrhosis of the liver while peptic ulceration was suspected in one patient who alao had amoebic dysentery and urinary hllharsiesis. None of the Africans had Idiopathic iron deficiency anaemia with the possible exception of one who had 4 Caesarean sections in rapid succession. There were 175 Indians, 175 Africans and 139 Europeans who were studied haematologlcally during pregnancy. The Incidence of iron deficiency anaemia among them was 26.7%, 2% and 4% respectively. The third aspect of the thesis is confined to an analysis of necropsy materiel for iron stores. Two hundred Africans and 58 Indians were studied. It was found that the incidence of *siderosis" in the African was high. There was a significant difference in the iron concentrations in the stores of the 2 racial groups. It was concluded that iron deficiency anaemia is common in the Indian. Diet appears to play an important role in its production.
The blood groups of the Natal Indian people.
(1980) Moores, Phyllis Patricia.; Bain, Peter G.
No abstract available.
Human blood groups and antibodies.
(1991) Moores, Phyllis Patricia.
The following blood group phenotypes and antigens were studied: Abantu , Ax, Ay, Bm, Bm-like, B3-like, "Bombay" Oh Le(a+b-), "Bombay" Oh Le(a-b-), para-Bombay, Mi(a+), Vw+, S-s-U-, Dantu, Gerbich-, P1H, STEM+, Rh :-34, Rhnu11 , Le(a-b-c-d-), McC(e+) and Wd( a+) and a new form of polyagglutination associated with haemoglobin M - type Hyde Park. The effect of inheriting a y, D--, Dc- or R1Lisa haplotype was also investigated. The following blood group antibodies were studied: anti-N in a person with type MN red cells, anti-hrs, anti-Rh34, anti-Jsb and anti-T. Type M red cells were confirmed to absorb anti-N and type N red cells not to absorb anti-M. A new technique was described for separating the two red cell populations in twin chimeras. Three XX/XX female dispermic chimeras with blood of two genetic types, two with patchy skin pigmentation, were identified. Reduced I and enhanced i antigen expression helped confirm a case of congenital dyserythropoietic anaemia type II. Oval red cells accompanying an r (dce) haplotype were found, and anti-Tja-like haemolysins were not detected in women about to abort. Aspects of haemolytic disease of the newborn due to ABO and Rh antibodies were discussed. Two new tests in which 2-mercaptoethanol was used to distinguish between IgG (7S) and IgM (19S) immunoglobulins were described. Blood group phenotype and gene frequency studies were made in Black, White, Indian and Coloured blood donors and the results were presented in 32 tables. Thirty monoclonal anti-A and 96 monoclonal antibodies for antigens in the ABO, MNSs, Rh, Lutheran, Kell, Lewis and Kidd systems and for other antigens were investigated for their activity and specificity.
Coagulation system abnormalities in human immunodeficiency virus (HIV) positive African (Black) patients with acute upper segment deep vein thrombosis(DVT) of the lower limbs.
(2006) Bassa, Fatima Cassim.; Poovalingam, V.
Background Several case reports and studies have alluded to an increased prevalence of venous thrombosis in human immunodeficiency virus positive (HIV-positive) patients. Although a relationship between HIV infection and thrombotic disease has been suggested, the mechanisms predisposing to thrombosis have not been fully elucidated. Aim A prospective study, to determine possible coagulation factor abnormalities that could explain the predisposition to thrombosis in HIV-infected African (Black) patients, was undertaken. Method African (Black) patients, with acute upper segment deep vein thrombosis (DVT) confirmed by duplex ultrasound, were enrolled. Patients who had recognisable risk factors such as recent surgery, pregnancy or malignancy, were excluded. After informed consent, blood samples were taken for baseline tests as well as a thrombophilia screen. The control group comprised known HIV-positive African (Black) patients without DVT. Patients with DVT who were found to be HIV-negative were also analysed. Analysis was done in 2 parts: HIV-positive patients with and without thrombosis and HIV-positive and negative patients with thrombosis were compared. Results Part A: HIV-positive patients with and without thrombosis Of the 77 patients with DVT, 50 patients tested HIV-positive. These 50 patients (HIV-positive DVT-arm), as well as 56 controls (HIV-positive, no DVT), were enrolled into the study. The groups were well matched with regard to age, sex and cluster designation 4 (CD4) count. On univariate analysis, significant findings in the DVT-arm were a history of active tuberculosis on treatment, low protein C levels and a positive qualitative D-dimer, whereas on multivariate analysis, only tuberculosis and an elevated D-dimer proved to be significant. Part B: HIV-positive and negative patients with thrombosis There were 20 HIV-negative patients with DVT who met our inclusion criteria Limited assessment was done on this group owing to unavailability of some data. The mean age of the HIV positive DVT group was significantly lower than the HIV-negative group with DVT (31.78 vs. 41.45 years; p=0.005). There was no significant difference in the prevalence of tuberculosis between the HIV-positive and HIV-negative patients with thrombosis (p = 0.269). Mean protein C levels were reduced in the HIV-positive group and normal in the HIV-negative group. They were significantly lower in the HIV-positive patients compared to the negative group (p=0.02). Conclusion The findings of the study suggest a relationship between HIV, its complications and DVT. Although this study confirms HIV infection as a risk factor for thrombosis, clear pathogenetic mechanisms remain to be elucidated. In our population, tuberculosis appears to be an important risk factor predisposing patients to the development of DVT, both in the HIVpositive and negative population. Further studies will need to be done to confirm this hypothesis.
Distribution of PML-RARA isoforms in Acute promyelocytic leukemia patients from a tertiary hospital in KZN, South Africa using qPCR.
(2017) Safiya, Ebrahim.; Gordon, Michelle Lucille.; Parsanath, Sharlene.
The study of genetic epidemiology of cancers in Africa is unique as compared to first world countries, as it entails the combination of gene-environment interaction, poor socio-economic conditions and the high prevalence of infectious (e.g. tuberculosis and HIV) and non-infectious diseases. Acute Promyelocytic Leukemia (APL), a subtype of Acute Myeloid leukemia (AML) if not diagnosed within 24 hours because of its hemorrhagic tendencies, becomes a medical emergency. It has become one of the most treatment-responsive cancers due to its excellent response to all trans-retinoic acid (ATRA). Advances in molecular diagnostics have resulted in a reversetranscriptase polymerase chain reaction (RT-PCR) test to detect the PML-RARA (retinoic acid receptor alpha) transcript found in APL’s. Globally, many centers have investigated the different breakpoint cluster regions (bcr) to classify the patients into different prognostic groups for specific molecular targeted treatment. However, there are no reports from Africa on the frequency of the different isoforms in APL patients. In this study we aim to identify and determine the frequency of bcr isoforms in APL patients from a tertiary hospital in Kwa Zulu Natal (KZN) by quantitative RT-PCR (qPCR). The correlation of the hematological parameters with the different isoforms was analyzed by descriptive non-parametric statistical analysis. The qPCR confirmed bcr1 to be the predominant isoform (63,6%) followed by bcr3 (31,8%) and bcr2 (4,5%). There was a median age group of less than 45 in our patient cohort. Patients with the bcr3 isoform had a poor prognosis according to their clinical risk stratification but this did not necessarily result in poor overall survival when monitored for minimal residual disease (MRD). The HIV-infected APL patients with different isoforms responded to “standard of care” treatment in the same way as noninfected HIV patients.
Profile and management of AIDS related lymphoma.
(2022) Rapiti, Nadine.; Moosa, Mahomed Yunus Suleman.
Worldwide, HIV-associated lymphoma (HAL) is a common HIV-related malignancy. Most are aggressive, high-grade B cell malignancies and are classified as AIDS Related Lymphomas (ARL). ARL include Diffuse large B cell lymphoma (DLBCL), Burkitt lymphoma (BL), and less commonly, plasmablastic lymphoma (PBL), primary effusion lymphomas (PEL) and primary central nervous system lymphoma (PCNSL). Prior to antiretroviral therapy (ART), the incidence of lymphoma was 60-200 fold higher than that seen in HIV-negative subjects, but this has decreased to 11-25 fold with the widespread use of ART. The prevalence of HIV in South Africa (SA) is estimated at 13.5% (8 million people), with the province of KwaZulu-Natal (KZN) leading other provinces at a seroprevalence rate of 18%. Most patients in SA access medical care through government health facilities. King Edward Vlll Hospital (KEH) is a government-funded, tertiary health care centre affiliated with the academic hospital of the Nelson R. Mandela School of Medicine of the University of KwaZulu located in Durban, KZN. Most ARL in the indigent population, other than BL, are treated at KEH. The aim of this original research was to describe the profile, outcome and prognostic variables of ARL treated in a government hospital at the epicentre of the HIV/AIDS pandemic in KZN, and compare this to data described elsewhere in South Africa and internationally. There is limited data from South Africa on ARL, and no data from KZN. Globally, conventional chemotherapy for ARL has been supplemented by rituximab, which is a monoclonal antibody targeting CD20. A shift in treatment midway through this study period, to include the use of rituximab locally for CD20-positive ARL, provided an opportunity to compare outcomes with and without rituximab. Plasmablastic lymphoma is a challenging ARL, in terms of diagnosis and management. As this is an unusual lymphoma, with a prevalence of 0.004% of all lymphomas, there viii are no large, prospective trials. We describe our experience with the profile and outcome of this cohort of ARL patients, treated with combination chemotherapy. Outcome in lymphoma is guided by prognostic scoring systems, the international prognostic index (IPI) or the age-adjusted IPI (aaIPI). As these prognostic scoring systems have not been validated in the local population in KZN, the utility of these scoring systems was assessed in this research.
The prognostic of CD38 and CD49d flow cytometry markers in chronic lymphocytic leukemia: a retrospective 5-year study.
(2023) Voxeka, Siyabonga Eric.; Murugan, Stephanie.; Rapiti, Nadine.
Background: The prognosis of chronic lymphocytic leukemia (CLL) is determined by various prognostic markers. The importance of the immunophenotypic markers CD38 and CD49d on flow cytometry in CLL is well-established internationally. However, there is no data from South Africa on these markers. Objective: This study assessed the frequency of CD38 and CD49d expression in newly diagnosed CLL patients, and the correlation of these markers with other prognostic variables. Methods: A 5-year retrospective analysis was performed on all newly diagnosed CLL patients. The expression of CD38 and CD49d were correlated with haemoglobin concentration, platelet counts and markers by Fluorescence in situ hybridisation (FISH) analysis. Patient charts were obtained from the haematology clinic for 2-year overall survival (OS) analysis, and described using Kaplan-Meier survival curves. Results: Data from 86 newly diagnosed CLL patients were analyzed. Most of the patients, 70.9% (n=61), were between 60-79 years of age. The frequency of CD38 positivity was 29% (n=25), CD49d positivity was 15.1% (n=13), dual positivity for CD38 and CD49d was 15.1% (n=13) and dual negativity was 40.7% (n=35). Of the 37% (n=33) who had CLL FISH studies, seven had 13q deletion, ten had trisomy 12 and two had 11q deletion. CD49d expression correlated with trisomy12 with (p value 0.002). Conclusion: The incidence of CD49d expression in KwaZulu-Natal, was lower than that described in CLL internationally. Although there was some correlation with molecular abnormalities detected by FISH, further prospective studies are warranted to confirmif these immunophenotypic markers can be utilized as surrogate prognostic markers in CLL.

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